Medical
Bronchoscopy
Surgical Simulation: Bronchoscopy
The surgical simulation Endoscopy AccuTouch® System with bronchoscopy modules provides a wide range of bronchoscopy training scenarios. It was introduced in 1999, and since that time hundreds of customers have integrated the simulator into their training programs. Some of their experiences are documented below under Case Studies.
Many clinical studies related to the surgical simulator’s training effectiveness have also been performed and published in leading medical journals. A few of them are listed below under Clincial Studies.
A return on investment study was performed for this simulator by Frost & Sullivan. See the ROI tab for more information.
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Surgical Simulation of Bronchoscopy: Introduction
The Introduction to Bronchoscopy module for the Endoscopy AccuTouch System offers:
- A very realistic surgical environment
- Multimedia didactics for a better learning experience
- Objective, automated evaluations
- Comprehensive training objectives that cover many key aspects
Read more about Intro to Bronchoscopy
Realistic Bronchoscopy Simulation Training
The Introduction to Bronchoscopy module includes several teaching tools for learning the basics of bronchoscopy:
- Road signs, superimposed over the display can be switched on to provide international nomenclature for the pulmonary anatomy, allowing users to orient themselves and solidify their understanding of anatomy and terminology.
- The bronchoscope looks, feels, and handles like a real scope, allowing users to perfect their technique.
- The anatomy is derived from actual patient data and looks and behaves like real tissue; mucus clouds the scope and red-out occurs when the scope collides with airway walls.
- Physiological responses, such as changes in vital signs and coughing result from the user’s actions.
- The simulation contains realistic features such as suction, video capture, and lidocaine and saline dispensing.
Multimedia Content Supports Visualization
The Introduction to Bronchoscopy module includes extensive videos covering the entire procedure, from holding the scope to navigating the airways. An interactive 3D anatomy model shows the tracheobronchial tree and adjoining anatomic structures. An external view helps users visualize the location of the scope.
Objective, Automated Evaluation Report
A thorough evaluation report is automatically generated every time a user proceeds through a case. All reports are stored in a password-protected database to provide user-specific documentation of training and competency. Items recorded include:
- Time to complete the procedure
- Percent of bronchial segments entered
- Order of the bronchi visualized
- Number of scope collisions with the airway wall
- Aliquots of lidocaine and saline used
- Details of the tracheobronchial inspection
Bronchoscopy AccuTouch SystemTraining Objectives
Upon completion of the Introduction to Bronchoscopy module, the user will be able to:
- Discuss the indications, contraindications, and complications of flexible bronchoscopy and the skills necessary to perform a bronchoscopic examination of the upper and lower airway
- Describe and perform the correct technique for holding and manipulating the bronchoscope
- Discuss the anatomic structures external to the lungs that are relevant to the bronchoscopist and the spatial relationship of the tracheobronchial tree to adjacent anatomic structures
- Describe the procedural steps necessary to perform a complete bronchoscopic examination of the upper and lower airway
- Understand the anatomy of the upper and lower airway as viewed through a bronchoscope
- Visualize the structure of the tracheobronchial tree and identify a variety of endobronchial lesions
Surgical Simulation of Bronchoscopy: BAL and Endobronchial Sampling
This BAL and Endobronchial Sampling module allows the user to experience realistic tool/tissue interaction. The patient breathes, coughs, and exhibits changes in vital signs based on users actions. The training simulator offers:
- A realistic and immersive bronchoscopy training environment
- Automatic evaluation report
- Training in technique and the bronchoscopy procedure
Read more about BAL and Endobronchial Sampling
Realistic Bronchoscopy Simulation Training
The Endoscopy AccuTouch System delivers realistic, procedure-based content for cognitive and motor skills training. The Bronchoaleolar Lavage (BAL) and Endobronchial Sampling module includes several teaching tools:
- Road signs, superimposed over the display can be switched on to provide international nomenclature for the pulmonary anatomy, allowing users to orient themselves and solidify their understanding of anatomy and terminology.
- An external view helps the user visualize the location of the scope.
- A Virtual Assistant (advice) can be turned on, offering advice during independent practice.
- A video capture button allows for pictures of the pathology to be taken and stored.
The sampling tools for this surgical simulation module include a needle, forceps, and brush -- all entering via the working channel of a realistic bronchoscope.
The interaction of the tools with pathology enhances the realism through deformation of tissue and realistic bleeding.
Evaluation Report Provides Documented Results
A thorough evaluation report is automatically generated every time a user proceeds through a case. All reports are stored in a password-protected database to provide user-specific documentation of training and competency.
Items recorded include:
- Time to complete the procedure
- Percent of bronchial segments entered
- Order of the bronchi visualized
- Number of scope collisions with the airway wall
- Aliquots of lidocaine and saline used
- Details of the tracheobronchial inspection
Bronchoscopy Procedural Training Objectives
Upon completion of the BAL and Endobronchial Sampling module, the user will be able to:
- Discuss the procedural steps performed during BAL
- Understand the correct positioning of the bronchoscope necessary for a BAL
- Describe pathological conditions that require a BAL
- Discuss the use of forceps, needles, and brushes for sampling endobronchial lesions
- Describe the procedural steps performed to obtain an endobronchial sample
- Understand the correct positioning of the bronchoscope necessary for a biopsy
- Describe common complications that can occur when sampling endobronchial lesions with a forceps, needle, or brush
Surgical Simulation of Bronchoscopy: Transbronchial Needle Aspiration (TBNA)
In the TBNA module, the user learns to correctly use a cytology needle to biopsy a lymph node. The module includes features that let trainees:
- Learn procedural skills through realistic simulations
- Increase practical knowledge and experience
- Receive objective, automated evaluations
Read more about the TBNA module
Realistic Bronchoscopy Simulation Training
The Transbronchial Needle Aspiration module includes several teaching tools to help users accurately navigate through the tracheobronchial tree, correctly locate biopsy sites, and safely use the cytology needle:
- Force feedback duplicates the feel of bronchoscope navigation and cytology needle use
- Needle penetration deforms tissue and causes bleeding
- Patients exhibit physiological changes based on users’ actions
- Interactive anatomical maps show the location of lymph nodes relative to the tracheobronchial tree
- Transparency feature allows users to visualize pathology shape and location
- Photos of actual TBNA cytology specimens illustrate a variety of possible aspirate samples
- CT images provide context for learning diagnostic skills and a "Virtual Attending" feature advises the user on correct technique and warns of potential harm to the patient
Onboard Didactics Broadens Curriculum
The module’s didactic content covers:
- Basic anatomy
- Patient selection tools
- Techniques
- Complications of TBNA
Upon completion of the TBNA Module users will be able to:
- Discuss the indications, contraindictions, and complications of TBNA
- Identify the approximate locations of the 11 mediastinal lymph node stations
- Discuss the use of the cytology needle for TBNA
- Describe the correct technique for performing TBNA, including obtaining a nodal sample
- Perform a simulated transbronchial needle aspiration
Automatic Evaluation Documentation
A thorough evaluation report is automatically generated every time a user proceeds through a case. All reports are stored in a password-protected database to provide user-specific documentation of training and competency.
Items that are recorded include:
- Total procedure time
- Number of needle punctures
- Number of successful aspirations and vessel punctures
- Details of potential scope damage
- Details of potential sample contamination, including the number of times scope suction was used prior to completion of aspirations and the number of times the needle was withdrawn from a node before suction was broken
Surgical Simulation of Bronchoscopy: Endobronchial Ultrasonography (EBUS) and Transbronchial Needle Aspiration (TBNA)
The module includes features that allow trainees to:
- Learn diagnostic skills
- Receive training objectives for mastery
- Experience a realistic medical environment
- Obtain objective, automated evaluations
Context for Learning Diagnostic Skills
The module’s simulation includes:
- Basic airway and mediastinal anatomy
- Realistic EBUS-TBNA tool use
- Ultrasound with color Doppler and TBNA Techniques
- Complications of EBUS-TBNA
- CT images provide context for learning diagnostic skills
- A "Virtual Attending" feature advises the user on correct technique
Training Objectives for Mastery
Upon completion of the EBUS-TBNA Module users will be able to:
- Discuss the contraindications and complications of EBUS-TBNA
- Identify the locations of mediastinal lymph node stations viewed endobronchially
- Understand how to perform a TBNA under ultrasound guidance
- Describe the correct technique for performing EBUS-TBNA, including obtaining a nodal sample
- Perform a simulated EBUS-TBNA
Realistic Bronchoscopy Simulation Training
The Endoscopy AccuTouch System delivers realistic, procedure-based content for cognitive and motor skills training. The system consists of a PC, an interface device with interchangeable anatomy, proxy endoscopes, and software modules for a wide range of training scenarios.
The EBUS-TBNA module includes several teaching tools to help users accurately intubate the vocal cords with an EBUS bronchoscope, navigate through the bronchial tree, use ultrasound and color Doppler to distinguish between vessels and lymph nodes, correctly locate needle aspirate sites, and safely use the EBUS-TBNA needle:
- Force feedback duplicates the feel of bronchoscope navigation
- Needle penetration deforms tissue and causes bleeding
- Patients exhibit physiological changes based on users’ actions
- Interactive anatomical model shows the location of lymph nodes relative to the tracheobronchial tree
Evaluation Report Offers User-Specific Documentation
A thorough evaluation report is automatically generated every time a user proceeds through a case. All reports are stored in a password-protected database to provide user-specific documentation of training and competency.
Items that are recorded include:
- Total procedure time
- Number of needle punctures
- Number of successful aspirations and vessel punctures
- Details of potential scope damage
- Details of potential sample contamination
- Proficiency of target sampling
- Completeness of node station evaluation
Surgical Simulation of Bronchoscopy: Pediatric Difficult Airways
The Difficult Airways module provides several tools for learning how to use a bronchoscope to place an endotracheal tube in a pediatric patient. It trains on the technique needed to navigate through the anatomy of the upper airway. The module includes features that let trainees:
- Become proficient in the technique
- Use training tools to speed learning
- Receive objective, automated evaluations
Read more about Pediatric Difficult Airways
Training for Proficiency
Upon completion of the Pediatric Difficult Airways module, the user will be able to:
- Understand the anatomy of the upper airway as viewed through the bronchoscope.
- Appreciate the difference in the airway anatomies of children of different ages.
- Understand the correct technique for operating the bronchoscope.
- Discuss the technique for advancing the bronchoscope through a difficult airway.
- Appreciate the dynamic responses of the airway to the presence of the bronchoscope.
- Discuss the anesthetic management of the patient with a difficult airway.
Simulated Training Speeds Learning
The Difficult Airways module provides several tools for learning how to use of a bronchoscope to place an endotracheal tube in a pediatric patient:
- A navigational view that lets users visualize the location of the scope in relation to the anatomy can be toggled on and off.
- Novice users can choose a Static View, with the patient paralyzed, to learn proper technique before moving on to the more challenging Dynamic View, with the patient spontaneously breathing.
- A Virtual Assistant foot pedal allows for independent operation of the simulator.
- The bronchoscope looks, feels, and handles like a real scope, allowing users to perfect their technique.
- The patient breathes, coughs, and exhibits changes in vital signs based on users’ actions.
- A jaw thrust can be performed to better visualize the glottis.
- The patient’s airway responds to the dispensing of volatile, intravenous, and topical anesthetics.
Evaluation Report Offers User-Specific Documentation
A thorough evaluation report is automatically generated every time a user proceeds through a case. All reports are stored in a password-protected database to provide user-specific documentation of training and competency. Items recorded include:
- Successful placement of the ET tube
- Time to complete the procedure
University of Aberdeen Clinical Skills Centre
Medical Simulation Promotes Training Excellence
Challenge
- Educate both novice and experienced physicians
- Provide a cost-effective platform for learning several procedures
- Allow skills maintenance
Solution – More Complete Training with Immersion’s Endoscopy AccuTouch System
- Enables physicians to identify and address common complications, become familiar with the devices used during the procedure
- Independently determines skill levels using automated performance metrics
- Patented force feedback technology offers as close to a real feel for the procedure as possible
Outcome – Faster Learning on a Variety of Procedures
- Used the same machine for training on upper and lower GI and brochoscopy procedures
- Purchased Immersion Medical’s vascular access system to train nursing students in intravenous insertion
- Helped to speed learning
- Helped physicians refresh skills
Beth Israel Deaconess Medical Center
Simulations Offer Safe, Effective Bronchoscopy Training
Challenge
- Improve patient safety
- Provide enough cases to achieve competency
- Accelerate bronchoscopy training
- Broaden experience for fellows, attending physicians, private practitioners, plus pulmonary and surgical staff
Solution – Provide Realistic Bronchoscopy Experience with Immersion’s Medical Simulator
- A robust system that stands up to heavy use
- Available 24/7
- Allows trainers to evaluate students before they perform on patients
- Allows staff to learn new minimally invasive procedures
Outcome
- Increased student satisfaction
- More exposure to procedures and more opportunity to gain experience in a wide variety of cases
- Improved patient safety with better training in endoscopy
- Secured an objective qualification tool for clinical procedures
Northwestern Memorial Hospital
Medical Simulation Provides Realistic Training
Challenge
Improve bronchoscopy training for resident physicians
Solution – Immersion’s Endoscopy AccuTouch System
- Provide the look and feel of actual procedures
- Rely on anatomic models developed from actual patient data
- Increase learning with force feedback transmitted through the flexible scope that mimics the actual feel of a procedure
Outcome
- Fast skills acquisition
- Better understanding of anatomy
- Assessment of motor skills and cognitive knowledge of procedure
- Increased resident confidence
- Reduced procedure time and patient discomfort
Ft. Wayne Medical Education Program
Medical Simulation Training Spreads Skills to Rural Physicians
Challenge
- Increase training opportunities in endoscopic procedures for family practice residents
- Help residents to complete the American Board of Family Physicians curriculum
- Increase skill sets of rural doctors to avoid the need to refer patients to distant specialists
- Give residents more opportunities to perform endoscopic procedures
Solution – More Procedure Practice with Immersion’s Endoscopy AccuTouch System
- Allows physicians to develop a “feel” for the procedures
- Provides a realistic feel for insertion and withdrawal, and visuals of the anatomy and pathology
- Residents learn how to navigate the tools and the steps of the actual procedure
- Easy to move around for demonstrations, practice sessions, or other training purposes
Outcome – A True Picture of Competency
- Post-simulation evaluation report allows residents and attending physicians to analyze the procedure objectively, assess overall performance, determine areas for skills enhancement, and define further training
- Provides details on the number of centimeters the scope is advanced, the amount of pressure applied to the side wall, and whether the student saw everything they were supposed to see
- Enables doctors to demonstrate proficiency that earns them hospital privileges
ROI
An independent six-month study to determine the payback period for Immersion Medical simulators has concluded with
- A report (PDF) on the elements that contribute to ROI
Download the report now. - Median ROI periods
About the Study
- The study was possible because Immersion Medical simulators have been in use by hospitals and training programs for a sufficient period of time to allow an in-depth evaluation of their performance.
- Detailed interviews and surveys of 237 attending staff physicians, residency directors, nursing directors, nurses, risk managers, and CFOs or controllers in hospitals, universities, and community colleges across the U.S. were used.
- The Health Research and Educational Trust (HRET), the research affiliate of the American Hospital Association, provided access to the study's control group - 145 medical personnel who did not use Immersion Medical simulators.
- The study was performed by Frost & Sullivan, a world leader in growth consulting and competitive intelligence; corporate strategy and best practices; training; and technology, market, economic, and customer research.
